Debbie Perlman Blog

   Dual-eligible Medicare beneficiaries were more likely to experience the social determinants of health than non-dual eligibles.    Over half of dual-eligible Medicare Advantage beneficiaries experience the social determinants of health, revealing a need for better social health programming within the program, according to data presented by Avalere at ISPOR 2019. The data, which included administrative claims, CMS data, and other data linked with zip-code level information for nearly 2 million beneficiaries, revealed that more vulnerable Medicare beneficiaries yield poorer outcomes. Specifically, these members have poorer health, higher utilization rates, higher healthcare spending, and lower quality measure scores. The researchers looked at the socioeconomic status of dual-eligible members, or members who qualify for both Medicare and Medicaid. While dual-eligible benefits usually vary by state, it tends to be a marker of extreme health need. Patients rec

  Medicare, Medicaid, and private payers covered 82 percent of prescription drug spending in 2017.   Total prescription drug spending reached $333 million in 2017, but the way that lump sum was divided among Medicare, Medicaid, and employer-sponsored health plans may reveal differences between the populations each payer covers, according to a May analysis from the Kaiser Family Foundation (KFF). The analysis, which looked at claims data from large, employer-sponsored health plans, Medicare Part D plans, and Medicaid, revealed that some payers cover more of that $333 billion figure than others do, likely because of the complexity and size of the populations they cover. Combined, employer plans, Medicare Part D, and Medicaid covered 82 percent of all prescription drug spending in 2017, while out-of-pocket patient costs covered 14 percent. Broken down by payer, the analysis showed that private insurers ate the biggest piece of the prescription spending p

Does my health plan cover my current doctor? Call your doctor’s office directly and ask if they accept your coverage. You can also check your health plan’s website and their provider directory. You may also want to ask your plan if you need prior authorization before your visit. Without it, you may be charged for things your health plan would have paid for. Does my health plan cover the services I need? All private health insurance plans offered in the Marketplace offer the same set of essential health benefits, including prescription drugs, emergency services, and pregnancy, maternity, and newborn care. Some plans may also offer additional coverage. If you have questions about whether a service is covered, contact your plan. What will my costs be? Most health plans give you the best deal on services when you see a doctor who has a contract with your health plan (also called an "in-network" provider). You may be able to see doctors who don’t contract

The Trump administration has decided to put part of its Medicare drug cost-cutting proposals on hold, for now, announcing that it will not give health plans the authority to negotiate pricing for certain drugs considered protected classes and will not require pharmacies to make sure Medicare patients get the lowest price on prescriptions. The Centers for Medicare and Medicaid said Thursday it will not be implementing its lowest pharmacy price proposal for 2020, after receiving more than 4,000 comments on the rule. “CMS is continuing to carefully review these comments as we continue to consider policies that would lower prescription drug costs, address challenges that independent pharmacies face, and improve the quality of pharmacy care,” the agency said. The administration also said it is not implementing a proposal, announced last fall, that would have allowed private Medicare Advantage and Part D drug plans to negotiate prices on so-called protected classes of

Congress held its first-ever hearing on "Medicare for All" legislation that was filled with emotional testimony from single-payer advocates as well as heavy skepticism from Republicans about upending the current health care system. The House Rules Committee heard six hours of testimony on the Medicare for All Act of 2019, a proposal introduced by Democratic Reps. Pramila Jayapal and Debbie Dingell that would eliminate private insurance companies and have all Americans on a government-run plan. While a number of Democratic leaders haven't gotten behind the overhaul plan, "Medicare for All" has gained momentum within the party with 100 co-sponsors in the House and a number of Democratic presidential contenders supporting the proposal. Ady Barkan, a 35-year-old single-payer activist who has ALS, expressed the urgency to shift to a "Medicare for All" system in his emotional testimony. Barkan became a face of the movement when

Safety net health clinics have fared better in states that have expanded Medicaid coverage to more low-income residents than those in states that have not expanded the health program, according to a new survey. Federally qualified health centers, along with look alike clinics that lack the same grant funding, provide low-cost primary, behavioral health and dental care, serving millions of people – and 1 in 6 medical patients across the country. Federally qualified health center patients are more likely to suffer from chronic conditions, but the centers spend considerably less to care for patients than other providers. The Affordable Care Act allocated $11 billion to operate and expand such community health centers over a five-year period. Since the law was enacted in 2010, millions of low-income people have obtained health coverage, in large part through the act's push for states to expand Medicaid coverage. The survey and accompanying report from the Commonweal

Americans can insure just about anything. Drivers are required to get automobile insurance, renters and homeowners insure against theft and damage, and businesses must protect themselves from lawsuits. This is just skimming the surface; the Insurance Information Institute reported that $1.1 trillion in premiums were paid to insurance companies in 2014 to insure everything from properties to pets. To handle the demand, the industry employed about 2.5 million people to set premiums, sell plans, evaluate claims and perform other essential functions. This guide gives readers information about careers within the insurance sub sector along with related degree information, corresponding salaries and job outlook.                         Insurance Degrees and Career Paths                                                                  1.Actuary:   Actuaries assess risk so they can set premiums. They usually specialize in one type of insurance. For instance, propert